Todd E. Schlesinger, MD, FAAD, FASMS: In my practice I see advanced cases of cSCC on a regular basis. Being a community-based dermatologic surgeon, Mohs surgeon and medical dermatologist, these cases are seen in our clinic on a monthly basis, or…even on a weekly basis. They may present in multiple. Ways. They may present as advanced cases of the head and neck. For example, scalp, around the nose, on the ears, or even on the fingers and toes or other places. So, being that we do Mohs surgery in our practice, these cases present to us regularly and they’re something we have to watch for.

The metastatic rate of cutaneous squamous cell carcinoma varies. Approximately 7% to 30% of advanced cases can metastasize. And, of course, this depends on the tumor type, differentiation of the tumor, the location of the tumor, whether that tumor is recurrent or primary, and whether the tumor has been treated before. These all can affect the metastatic rate.

One of the most important factors that affects metastasis is location. So, tumors that are on a certain area such as the lips or the ears have a higher rate of metastases, possibly because they’re in closer proximity to lymphatic or hematologic channels. However, the tumor differentiation is also important. So poorly differentiated tumors, tumors that have multiple differentiation present within one tumor, larger tumors, tumors that are recurrent in the same location all can present with a higher risk metastases.

The other thing that’s important for metastases to be aware of is the immunologic status of the patient. Squamous cell carcinoma is an immunogenic tumor with a high-muted, with a high-mutagenic rate, squamous cell carcinoma has a high tumor mutational burden and, therefore, if the patient’s immunocompromised, that increases the risk for metastases.

Transcript Edited for Clarity

Transcript:

Todd E. Schlesinger, MD, FAAD, FASMS: In my practice I see advanced cases of cSCC on a regular basis. Being a community-based dermatologic surgeon, Mohs surgeon and medical dermatologist, these cases are seen in our clinic on a monthly basis, or…even on a weekly basis. They may present in multiple. Ways. They may present as advanced cases of the head and neck. For example, scalp, around the nose, on the ears, or even on the fingers and toes or other places. So, being that we do Mohs surgery in our practice, these cases present to us regularly and they’re something we have to watch for.

The metastatic rate of cutaneous squamous cell carcinoma varies. Approximately 7% to 30% of advanced cases can metastasize. And, of course, this depends on the tumor type, differentiation of the tumor, the location of the tumor, whether that tumor is recurrent or primary, and whether the tumor has been treated before. These all can affect the metastatic rate.

One of the most important factors that affects metastasis is location. So, tumors that are on a certain area such as the lips or the ears have a higher rate of metastases, possibly because they’re in closer proximity to lymphatic or hematologic channels. However, the tumor differentiation is also important. So poorly differentiated tumors, tumors that have multiple differentiation present within one tumor, larger tumors, tumors that are recurrent in the same location all can present with a higher risk metastases.

The other thing that’s important for metastases to be aware of is the immunologic status of the patient. Squamous cell carcinoma is an immunogenic tumor with a high-muted, with a high-mutagenic rate, squamous cell carcinoma has a high tumor mutational burden and, therefore, if the patient’s immunocompromised, that increases the risk for metastases.